14480 Brain Bleed Hemorrhage Intracranial Hemorrhage

Overview

A brain bleed – also called an intracranial hemorrhage – is a type of bleeding that happens inside your skull or in the brain itself. It is a serious medical emergency, because the build-up of blood can press on the brain and cause damage.

It is not as common as other types of stroke, but it is a significant medical emergency. Around 1 in 8 strokes is caused by bleeding in the brain.

A brain bleed can happen at any age, but it is more likely in older adults, people with high blood pressure, people taking blood-thinning medicines, and after a head injury.

Symptoms

Common symptoms

• Sudden severe headache (often described as the worst headache of your life)
• Nausea or vomiting
• Weakness or numbness on one side of the body
• Difficulty speaking or understanding speech
• Dizziness, loss of balance, or trouble walking
• Vision changes, like blurring or seeing double
• Confusion or difficulty paying attention

Causes

Main causes

• Head injury (such as from a fall or car accident)
• High blood pressure, which weakens blood vessel walls
• A bulging or weakened blood vessel (aneurysm) that bursts
• Abnormal blood vessels in the brain (arteriovenous malformation)

Risk factors

• Age (more common after 65)
• Taking blood-thinning medicines
• Smoking or heavy alcohol use
• Recreational drugs, such as cocaine
• Being a man (slightly higher risk)
• Previous brain bleed or family history of brain bleeds

When to see a doctor

See a doctor urgently if:

• You have a sudden, severe headache or any stroke-like symptoms
• You had a head injury and feel confused, sleepy, or are vomiting
• You have a seizure, weakness, or trouble speaking

Book a routine appointment if:

• You have high blood pressure that has not been well controlled
• You take blood-thinning medicines and you are planning surgery
• You have a family history of brain aneurysm and have concerns

Diagnosis

A doctor will usually suspect a brain bleed based on your symptoms and any recent head injury. The main way to confirm it is with a scan of your brain.

Tests that may be done

• CT (computed tomography) head scan – the quickest scan to look for bleeding
• MRI (magnetic resonance imaging) – a detailed scan of the brain
• Blood tests to check for bleeding or clotting problems
• Sometimes a CT angiogram or lumbar puncture (spinal tap) to get more information

What to expect at your appointment

You will be evaluated quickly in the emergency department. You may have blood tests and a head scan. The care team will stabilise you and plan the next steps. You will not be alone – your medical team will explain everything to you.

Treatment

Emergency treatment for a brain bleed aims to stop the bleeding, relieve pressure on the brain, and manage your symptoms. The exact plan depends on where the bleed is, how much blood there is, and your overall health.

Self-care at home

• Rest and allow your brain to heal – avoid heavy lifting or straining
• Follow your care team's advice about when it is safe to return to normal activities
• Take your medicines exactly as prescribed (only those given to you by your doctor)

Medical treatments

Medicines may be given to lower blood pressure, reduce swelling in the brain, prevent seizures, or help with pain. In some cases, you may need medicines to reverse the effect of blood-thinning drugs. Your doctor will choose the right approach based on your situation.

When is surgery considered?

If the blood clot is large, pressing on the brain, or if there is bleeding from a damaged blood vessel, surgery may be needed to remove the clot or to repair the vessel. This is often done through a small opening in the skull.

Living with this condition

Recovery from a brain bleed takes time. Many people need rehabilitation, which may include physiotherapy to help with movement, speech therapy to help with talking and swallowing, and occupational therapy to help with daily tasks. You may need to take regular breaks and gradually build up your energy.

Lifestyle tips

• Keep regular follow-up appointments with your care team
• Manage high blood pressure with regular checks and a healthy lifestyle
• Avoid smoking and recreational drugs
• If you take blood-thinning medicines, always discuss any changes with your doctor

Diet and exercise

Eat a balanced diet rich in vegetables, whole grains, and healthy proteins. Limit salt and alcohol. Gentle exercise, such as short walks, can help with recovery – always check with your care team first about what level of activity is safe for you.

Mental health and emotional wellbeing

It is very common to feel anxious, low, or frustrated after a brain bleed. Your emotions may be affected by the injury itself. Talk to your doctor or care team about how you are feeling. If you ever have thoughts of harming yourself, this is a medical emergency – call your local emergency number or crisis line immediately.

Prevention

Many brain bleeds can be prevented by controlling high blood pressure, avoiding smoking, limiting alcohol, wearing helmets during activities like cycling, and always wearing a seatbelt.

Vaccines

There is no vaccine that prevents a brain bleed, but staying up to date with vaccines can help prevent infections that might increase your risk of complications.

Screening programmes

There is no routine screening test for brain bleeds in the general population. Your doctor may recommend imaging if you have a family history of aneurysm or other known risk factors.

Complications

If left untreated

• Brain damage and permanent disability
• Problems with memory, speech, or movement
• Seizures that continue
• Coma or death

Long-term outlook

The outcome after a brain bleed depends on many factors, such as the size and location of the bleed and how quickly you get medical care. Many people make significant progress, especially with early treatment and rehabilitation. Even after a serious brain bleed, many people return home and regain their independence. Staying positive and following your care plan can make a big difference.

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